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Clin Med 2 > Biliary Tract and IBD > Flashcards

Biliary Tract and IBD Flashcards

1
Q

What is the most common type of gallstone?

A

Cholesterol (yellow in color)

Followed by Black pigment and brown pigment (brown associated with infections)

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2
Q

Complications of cholelithiasis

A

Biliary colic (pain)
Cholecysitits
Choledocholithiasis (stuck in the bile duct)
Cholangitis (life threatening infection)

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3
Q

Biliary Colic

A

RUQ pain, crescendo/decrescendo

Gallbladder contracting pushing a stone against the outlet

Typically precipitated by a fatty meal

Dx. US

Tx. Ursodoxycholic acid , cholecystectomy

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4
Q

How do you feel pain in the gall bladder?

A

Stretch receptors

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5
Q

How can you tell the difference between stones and polyps of the gallbladder on US?

A

Acoustic shadowing is confirmatory for gallstones

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6
Q

Acute cholecytitis

A

Constant and severe RUQ pain, radiation to shoulder

Fever, N/V

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7
Q

How do you dx acute cholecystitis?

A

Murphy’s sign (have pt inhale)

US, CT scan

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8
Q

What is the treatment for cholecystitis?

A

Cholecystectomy

If super ill and not surgical candidate — cholecystotomy

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9
Q

Once the stone reaches the bile duct there is a ____% chance it will pass on its own

A

20

Meaning the gallstone stays there 80% of the time and can lead to chronic inflammation or stricture, etc

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10
Q

Charcots triad

A

Fever, RUQ pain, jaundice

Seen with cholangitis

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11
Q

Reynolds Pentad

A

Charcots triad (fever, RUQ pain, jaundice) + sepsis and mental status change

See with cholangitis

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12
Q

How do you dx cholangitis?

A

US, CT, ERCP (ERCP is also treatment)

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13
Q

How do you treat cholangitis?

A

ERCP with stone removal/stent

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14
Q

Primary Sclerosing Cholangitis

A

Inflammatory cholangitis (not infection)

Destruction of biliary system

Commonly seen with IBD (UC MC)

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15
Q

How do pts with PSC present?

A

Primary sclerosing cholangitits

Asymptomatic
Abnormal LAE’s

Dx. Cholangiogram (MRCP)

ERCP used to be gold standard but you have the risk of introducing infection into the biliary system

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16
Q

What are complications of cholangitis?

A

Stones
Strictures
Cholangiocarcinoma
Higher risk of colon cancer (in pts with UC)

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17
Q

Who is more likely to get primary sclerosing cholangitis?

A

Ulcerative cholitis pts

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18
Q

What is the most common tumor of the bile duct?

A

Cholangiocarcinoma

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19
Q

Where is cholangiocarcinoma most common?

A

SE Asia

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20
Q

What are the risk factors of cholangiocarcinoma?

A

PSC
Choledochal cysts
Caroli’s disease
Biliary infeciton with Opisthorchis viverrini or Colonorchis sinesis

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21
Q

How do you dx cholangiocarcinoma?

A

CA 19-9 (DNA marker?)
EUS
ERCP
MRCP

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22
Q

How do you treat cholangiocarcinoma?

A

Surgical resection or liver transplantation

By the time the pt is presenting with jaundice is’t not good prognosis

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23
Q

Gallbladder Cancer

A

Higher incidence in India and South America

Most diagnosed in advanced stage
5 year prognosis - 0-10%

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24
Q

What are the risk factors of gallbladder cancer?

A

Cholelithiasis
Porcelain gallbladder
Polyps
PSC

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25
Q

When are polyps concerning for gallbladder cancer?

A

If they’re growing in size

Remove the gallbaldder

26
Q

Porcelain gallbladder

A

Seen with gallbladder cancer

If you see this ever you need to do cholecytectomy right away even if the pt is asymptomatic

27
Q

What kind of cancer is the majority of gallbladder cancer?

A

Adenocarcinomas

28
Q

How are most gallbladder cancers dx?

A

Incidentally during cholecystectomy

More advanced stage if symptomatic

29
Q

What is the treatment of gallbladder cancer?

A

Cholecystectomy +/- hepatic resection

30
Q

What is the age of onset for IBD?

A

15 - 30 y/o

31
Q

Ulcerative colitis

A

Disease of surface epithelium of the COLON (mucosa/submucosa)

Present in rectum, extends proximally, in a continuous fashion

(EVERYONE with UC has rectum involvement)

32
Q

What are the symptoms of ulcerative colitis?

A

Blood diarrhea
Mucus, tenesmus, urgency

Formed vs loose stool

Chronic - relapsing and remitting —-pt most likely has had a previous episode

33
Q

Tenesmus

A

The feeling of needing to defecate but you only pass air

Seen with UC

34
Q

If we are looking at histology of IBD, what are we looking for?

A

Long term inflammation

Cryptitis/crypt abscesses

35
Q

Where in the body does Crohn’s disease occur?

A

May involve ANY part of the GI tract from mouth to anus

Vast majority have inflammation in the TERMINAL ILEUM

You can have patches of inflammation (not continuous like UC) “skip lesions”

Often sparing the rectum

36
Q

What are the signs and sxs of Crohn’s disease?

A 
Abdominal pain 
Diarrhea
Weight loss 
Growth retardation 
Fever of unknown origin 
Family history 
RLQ mass 
Perianal disease 
Extraintestinal manifestations
37
Q

Weight loss is seen more commonly with UC or CD?

A

CD

38
Q

Tenesmus is seen with UC or CD?

A

UC

39
Q

Perianal dz is seen with UC or CD?

A

CD

40
Q

Skip lesions

A

Seen with CD

Any segment of the intestines can be involved and it doesnt have to be continuous

Most commonly terminal ileum is involved

41
Q

What do you see on colonoscopy for a pt with CD?

A

Apthus ulcers in the colon

42
Q

What infections can mimic Crohn’s disease?

A

TB

43
Q

What does CD look like on histology?

A

Non-caseating granulomas —-pathompenumonic

44
Q

Non-caseating granulomas

A

On histology

Crohn’s disease!

45
Q

Bloody diarrhea is seen with CD or UC?

A

UC

46
Q

Abdominal pain is seen with UC or CD?

A

CD

47
Q

Weight loss is seen with UC or CD?

A

CD

48
Q

Fever is seen with UC or CD?

A

CD

49
Q

Smoking is protective for which IBD?

A

UC

50
Q

What do you see on labs for IBD pts?

A 
Anemia 
Hyperalbuminemia 
Elevated sedimenation rate
Elevated C-reactive protein 
Fecal calprotectin
51
Q

ASCA

A

Antibody for CD

Seen with 55-65% of pts with CD

52
Q

pANCA

A

Antibody for UC

Seen with 50-65% of UC pts

53
Q

What imagining studies can you get for UC and CD?

A

Barium studies - small bowel series, enema

  • structural changes
  • high dose radiation

CT/MRI enterography

  • mucosal enhancement and submucosal edema
  • appropriate for advanced disease and complications (abscess, fistula)

Better for CD
Since it might be deeper in

54
Q

What are the extraintestinal manifestations of IBD?

A

Arthritis

  • seronegative spondyloarthropathies (peripheral arthritis)
  • ankylosing spondylitis (Central - axial - arthritis)

Skin disease (more common in UC)

  • erythema nodosum
  • pyoderma gangrenosum

Eye

  • Episcleritis
  • Uveitis

Bile Duct Lesions

  • Sclerosing Cholangitis
  • Cholagiocarcinoma
55
Q

What are the extraintestinal manifestations of IBD involving the skin?

A

MC seen in UC

Erythema nodosum 
Pyoderma gangrenosum (looks infectious but it is not)
56
Q

What eye diseases might been seen in pts with IBD?

A

Episcleritis
Uveitis

Again more common extraintestinal risk with UC (i think)

57
Q

What bile duct complications might you see with UC?

A 
Sclerosing cholangitis (more common) 
Cholangiocarcinoma
58
Q

Seronegative spondyloarthropathies

A

Peripheral arthritis seen with IBD pts

59
Q

Ankylosing spondylitis

A

Axial arthritis seen with IBD

60
Q

Colorectal Cancer and Ulcerative Colitis

A

A large pts of PSC have UC, but not a ton of UC pts have PSC

PSC pts should get annual colonscopy

61
Q

What is the treatment plan for UC?

A

Start with 5-ASA such as Pentasa

Steroids for acute flares

Immune modifying agents such as 6-mercaptopurine or Azathioprine (to prevent relapse)

If that fails look into biologics such as Abalimumab

Clin Med 2 (13 decks)

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